| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
35,208 |
33,865 |
$1.58M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,729 |
4,075 |
$1.18M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32,126 |
30,759 |
$844K |
| D1208 |
Topical application of fluoride, excluding varnish |
38,181 |
36,705 |
$583K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,912 |
4,581 |
$475K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,900 |
2,592 |
$379K |
| D0272 |
Bitewings - two radiographic images |
21,542 |
20,529 |
$353K |
| D1351 |
Sealant - per tooth |
16,385 |
5,433 |
$344K |
| D0330 |
Panoramic radiographic image |
7,372 |
7,110 |
$331K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,788 |
8,333 |
$294K |
| D0220 |
Intraoral - periapical first radiographic image |
26,320 |
24,873 |
$265K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,806 |
2,807 |
$252K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,956 |
21,338 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
7,385 |
7,224 |
$167K |
| D1110 |
Prophylaxis - adult |
2,611 |
2,515 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,194 |
888 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,474 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
743 |
633 |
$58K |
| D9420 |
|
968 |
943 |
$56K |
| D2335 |
|
525 |
271 |
$50K |
| D1354 |
|
3,709 |
1,427 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,799 |
1,710 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,297 |
1,113 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
181 |
128 |
$21K |
| D9110 |
|
595 |
564 |
$16K |
| D2330 |
|
256 |
166 |
$13K |
| D2332 |
|
21 |
14 |
$2K |
| D0603 |
|
172 |
165 |
$0.00 |